Claims Adjuster - Workers Compensation

The Claims Adjuster – Workers Compensation role is responsible for adjudicating complex workers compensation claims, ensuring compliance with company standards and industry best practices, and managing claim resolution and subrogation. Responsibilities Manage workers compensation claims, determining compensability and benefits due on long‑term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agencies. Develop and manage claim action plans to resolution, coordinate return‑to‑work efforts, and approve claim payments. Process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract. Manage subrogation of claims and negotiate settlements. Communicate claim action with claimant and client. Ensure claim files are properly documented and claims coding is accurate. Process complex lifetime medical and/or defined period medical claims, including state and physician filings and decisions on appropriate treatments recommended by utilization review. Maintain professional client relationships. Qualifications Education: Bachelor’s degree from an accredited college or university preferred; professional certification applicable to line of business preferred. Experience: Four (4) years of claims management experience or equivalent combination of education and experience required. Benefits & Work Environment Flexible work schedule. Referral incentive program. Agile work environment. Career development and promotional growth opportunities. Diverse benefits package – medical, dental, vision, 401(k) starting day one. When applicable and appropriate, reasonable accommodations will be considered. Statements in this description provide a broad overview of the role’s nature and duties. The company reserves the right to modify duties at any time. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. #J-18808-Ljbffr